Sunday, May 13, 2012

Dementia: a personal experience



Mum and i, six months before her death

By Meluse Kapatamoyo

Call it last-born charm, I had a way with my mother. I knew exactly how to turn her darkness into light. In her eyes, even in my late 20s, I was always her baby girl, her Mukala (last born), as she loved to call me. She loved me and I knew it! But all that changed in just one morning.

I had spent the whole day with her, laughing and reminiscing about my late dad. I insisted on giving her a manicure and pedicure and although I managed to convince her to allow me paint her nails, she said dad would not have approved. It was the first and only time that my mother ever had her nails painted. As I left that evening, I felt blessed to have her.

However, that was my last beautiful memory of the two of us together. The next morning, my sister and I woke up to a call that mum was acting strange and had been taken to hospital. When I got there, I found her sleeping but as soon as she opened her eyes, I immediately knew that something was seriously wrong.

There was no glow in her eyes and she did not look at me as she always did. In fact, she looked at me like some stranger, someone she had never seen before.
She had woken up that morning at 05:00 hours and had started packing, not saying a word. Even when she was eventually made to calm down, she did not speak and refused to eat.

As much as I hoped her condition would improve, it did not. Each day that came, it got worse and I saw the woman that gave birth to me disappear right before my eyes.

My family and I took turns in caring for her and one day, while in my care and after not having heard her voice for days, she looked at me inquisitively and asked, “Who are you”?  I felt like someone had gotten a knife and stabbed me straight in my heart. As tears rolled down my face, she added, “I think you are Joshua’s daughter”.
She was right. I took comfort in the fact that she still remembered my father’s name.

A few days later doctors had a diagnosis. Mum was suffering from dementia, a syndrome caused by a variety of brain illnesses that affect memory, thinking, behaviour and ability to perform everyday activities. Alzheimer’s disease is the most common cause of dementia and is said to contribute up to 70 percent cases.

That was not the bad news. The worst was that the condition had no cure. Up until that moment, I had never heard of dementia. My first instinct was to go home and Google the disease but I was too afraid to find out what ‘no cure’ meant for my mother. I choose to do what I thought I could handle at the time. I lived in denial and prayed that the doctors were wrong.

In the two months that followed, my mother went from being a woman to being a child. She mumbled words but never really spoke and continued to refuse to eat. Eventually, we were left with no choice but to feed her through a tube inserted in her nose. She couldn’t walk and had to be bathed.

On October, 26, 2010, three months later, mum died and we were left to deal with the after effects of the disease. I think my siblings will agree that most of it
has been emotional. Looking back, the signs of dementia were there but we all thought that at 71 years old, it was old age catching up with her.

But the World Health Organisation (WHO) says although dementia mainly affects older people, it is not a normal part of ageing.

That said, dementia, still remains one of the major causes of disability and dependency among older people worldwide affecting 35.6 million, with 7.7 new cases recorded each year. This number is expected to double by 2030 to reach 65.7 million and more than triple by 2050 to a staggering 115. 4 million.

And like in my mother’s case, lack of early diagnosis remains a major problem. Unfortunately only eight countries worldwide currently have national programmes in place to address dementia.

A new report titled Dementia: a public health priority, published by the WHO and Alzheimer's Disease International, recommends that programmes focus on improving early diagnosis, raising public awareness about the disease and reducing stigma and providing better care and more support to caregivers.

“We need to increase our capacity to detect dementia early and to provide the necessary health and social care. Much can be done to decrease the burden of dementia," says Dr Oleg Chestnov, assistant director-general, Noncommunicable Diseases and Mental Health at WHO.

 "Health-care workers are often not adequately trained to recognize dementia."

The report further points to a general lack of information and understanding about dementia, which has led to an increase in stigma and also delays in seeking diagnosis, health assistance and social support. This has contributed to the social isolation of both the person with dementia and their caregivers.

"Public awareness about dementia, its symptoms, the importance of getting a diagnosis, and the help available for those with the condition is very limited. It is now vital to tackle the poor levels
of public awareness and understanding, and to drastically reduce the stigma associated with dementia," says Marc Wortmann, executive director, Alzheimer’s disease International.

Most care-giving is provided by informal caregivers-spouses, adult children, other family members and friends.

The report notes that people who care for a person with dementia are themselves particularly prone to mental disorders, such as depression and anxiety, and are often in poor physical health themselves.

Many caregivers also suffer economically as they may be forced to stop working, cut back on work, or take a less demanding job to care for a family member with dementia.

During my mother’s illness, the entire family got involved in her care. Desperate to jog her memory, we had some aunties come to live with us so she could be around her peers. Unfortunately, that did not help. Eventually, a few weeks before her passing, a care giver was hired to help nurse her.

According to WHO, early stages of dementia include forgetfulness, losing track of the time and becoming lost in familiar places.

The late stage of dementia is one of near total dependence and inactivity. They include becoming unaware of the time and place, having difficulty recognizing relatives and friends and having an increasing need for assisted self-care, having difficulty walking and also experiencing behaviour changes that may escalate and include aggression.

If it all comes down to it, the one thing that you can offer a patient with dementia is lots of love and patience. As for you, the caregiver, you will need a good support system from family and friends, as the situation can be emotionally and physically draining.

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Thursday, April 19, 2012

Zambia to host Corporate Africa Partnerships conference

By Meluse Kapatamoyo

The 5th Corporate Africa Partnerships for Prevention and Care Health Conference is headed for Zambia this year under the theme “Building sustainable partnerships between Africa’s private and public sectors.

The interactive session will see leading investors and their suppliers’ chain engage in dialogue with the public sector and their developmental partners about the ingredients necessary to build lasting win-win partnerships which will generate tangible and measurable benefits to impact upon prevention and care in Zambia.

The panel will also table the conditions that need to be in place for mutual trust and a thriving environment conducive to partnerships, commitment and heightened expectations of both private and public sectors.

Corporate Africa Health Conference and Reports partners with foreign investors in health and medicare, governments, international and developmental agencies, including UNAIDS, World Health Organisation, and global and national business coalitions on HIV/AIDS, TB and Malaria.

It has risen to become the leading health intelligence and thought vehicle in the prevention of infectious diseases in Africa where it offers ideas and solutions to increase the efficacy of health in the private and public sectors, and for sustainable development investments in human capital, drug transfer and therapy.

The Zambia 2012 conference will be held from 1-3 July, under the patronage of the Ministry of Health and chaired by the National Medical Association.

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Tele-medicine reforms medical delivery in Zambia

By Meluse Kapatamoyo

The provision of efficient medical services remains a challenge in most Zambian health institutions let alone, military establishments, but the recent tele-medicine solution being provided by mobile phone company, Zamtel, is set to change all that.

Information and communication technology is enabling specialist doctors and medical staff at Maina Soko Military Hospital and Mount Eugenia Health Centre of Zambia Air Force in Lusaka West, conduct live tele-medicine sessions between the two hospitals.

This technology allows interaction via live video link by providing real-time health care consultation services. It stores data for the patient while capturing video and photos which are later sent to medical consultants for diagnosis and follow-up treatment.

Maina Soko Hospital currently houses most of the defence medical specialists and staff, remote military medical centres therefore refer complicated cases to the hospital, a process that is both inefficient and expensive.

Zamtel’s tele-medicine solution is expected to address these challenges by eliminating the time and cost associated with frequent travel between remote medical centres and Maina Soko Hospital. This will also allow for more rational use of the time and expertise of Defence Force medical specialists.

Zamtel Chief Executive Officer Dr. Mwanakatwe said “The tele-medicine solution is being delivered through a dedicated point-to-point connection and is able to eliminate, to a large extent, travel between remote medical centres and Maina Soko Hospital for both staff and patients.”

“This particular solution is readily available using the current Zamtel network infrastructure and is a mix of optical fibre and radio technologies. We stand ready to work with the government and the medical fraternity in order to bring about the efficient delivery of modern health care services in Zambia through tele-medicine,” added Dr Mwanakatwe.

The solution also provides for net meeting, web conferencing, e-learning, Internet access and data transfer.

The project is funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and US Department of Defence in partnership with the American International Health Alliance’s HIV/AIDS Twinning Centre and the Zambian Ministry of Defence Medical Services through Maina Soko Hospital.

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Thursday, March 29, 2012

Smartphones fighting disease in Kenya

By Meluse Kapatamoyo

Smartphones are set to outplay traditional paper survey methods in the gathering and transfer of disease information. Data collected with smartphones in a recent study has shown to have fewer errors and is more quickly available for analyses than data collected on paper, Kenya's Ministry of Health has revealed.

A survey by the Kenya’s ministry of Health and researchers working for Kenya’s Centers for Disease Control and Prevention found that the use of smart phones was cheaper than traditional paper survey methods used to gather disease information.

 “Collecting data using smartphones has improved the quality of our data and given us a faster turnaround time to work with it. It also helped us save on the use of paper and other limited resources” said Henry Njuguna, M.D for Sentinel Surveillance Coordinator at the Centers for Disease.

Findings showed that of a total of 1,019 paper-based questionnaires collected compared to the same number of Smartphones collected, only 3 percent of the surveys collected with smartphones were incomplete, compared to 5 percent of the paper–based questionnaires. In addition Smartphone data were uploaded into the database within 8 hours of collection, compared to an average of 24 days for paper-based data to be uploaded.

Results also indicated that the cost of collecting data by smartphones was lower in the long run than paper–based methods. For two years, the cost of establishing and running a paper–based data collection system was approximately $61,830 compared to approximately $45,546 for a Smartphone data collection system.  The fixed costs incurred when the systems were first set up were $12,990 for paper and $16,480 for Smartphone.

In their research, four surveillance sites were targeted and at each, officers identified patients with respiratory illness and administered a brief questionnaire that included demographic and clinical information. While some questionnaires were collected using traditional paper methods, others were collected using HTC Touch Pro2 smartphones using a proprietary software program called the Field Adapted Survey Toolkit (FAST).

Kenya, like Zambia, has joined other African countries who have turned to the use of mobile technology to gather and transfer disease information.

Recently, Zambia launched Mwana, a health initiative aimed at improving the prevention of HIV transmission from mother to child by bridging the gap between some of the country’s national testing laboratories and rural community health care workers.

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Wednesday, February 15, 2012

Beads aid women in family planning

By Meluse Kapatamoyo

There are growing concerns that side-effects, costs, ease of use, access and communication between couples often hinder the success of family planning methods.
CycleBeads, a colour –coded string of beads, are fast becoming a popular family planning method as the battle to ensure that women worldwide (especially those living in developing countries) have access to family planning methods besides injectables and pills.
The beads represent days of a woman’s cycle and help her use a natural family planning method called the Standard Days method, which is based on reproductive physiology. A woman’s “fertile window” (the days in the menstrual cycle when she can get pregnant) begins approximately five days prior to ovulation and lasts up to 24 hours after ovulation.
They are designed for women with cycles between 26 and 32 days long. This is the one medical criteria for using this option especially if they are being used to prevent pregnancy.
To use the beads, a woman simply moves a ring over the beads to track each day of her cycle. The colour of her beads lets her know whether she is on a day when pregnancy is likely or not and whether her cycle length is in the appropriate range for using this natural family planning method.
Efficacy studies conducted in several countries showed that when used correctly, CycleBeads and the Standard Days Method, are more than 95 percent effective in helping women avoid pregnancy.
In simple terms, less than 5 out of every 100 women who keep track of their cycle days and abstain from having unprotected intercourse on days 8 through 19 of their cycle days got pregnant during the first year of using the beads.
Women who failed to keep careful track of their cycle days or had unprotected intercourse on the same days were much more likely to get pregnant. For those that used the method correctly, but sometimes had unprotected intercourse on days 8 to 19, 12 out of 100 got pregnant during their first year of use. This means that in “typical use” CycleBeads’ effectiveness is approximately 88 percent. 
CycleBeads and the family planning method on which it is based, the Standard Days Method, were invented by the Institute for Reproductive Health at Georgetown University. The company, Cycle Technologies, launched CycleBeads in late 2002 once the efficacy results were published.
The World Health Organisation (WHO) estimates that as high as one third of maternal deaths could be prevented if unmet needs for family planning were to be eliminated. Unfortunately, 215 million women who want to avoid or delay pregnancy still have no access to modern contraception.
Speaking recently the International Family Planning Conference held in Dakar, Senegal, United Nations Population fund (UNFPA) executive director, Dr Babatunde Osotimehin, said, “As our numbers keep growing past 7 billion, and so many (people) suffer from poverty, poor health and lack of opportunities, it is more important than ever to ensure that every child is wanted and that everyone has the power and the right to manage their own fertility.”
CycleBeads are available and being used in over 50 countries in Africa, Latin America and Asia.
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Saturday, February 11, 2012

Chlorhexidine - A Saviour for Newborns through Umbilical Cord Care

By Meluse Kapatamoyo

The risk of an infant to infection and death can be reduced by as much as 20 percent by cleansing the newborn’s umbilical cord with the antiseptic chlorhexidine, a new study has revealed.

According to the study funded by the United States Agency for International Development (USAID) and Save the Children’s Saving Newborn Lives program, which was led by researchers at the Johns Hopkins Bloomberg School of Public Health and conducted in rural Bangladesh, is the latest in a series of studies showing that umbilical cord cleansing with chlorhexidine can save lives.

 A randomized controlled trial of over 29,000 infants in Bangladesh found that cleansing a newborn’s umbilical cord with chlorhexidine reduced an infant’s risk of infection and death by 20 percent.

Dr. Rajiv Shah, administrator of USAID said “giving birth and a child’s first week is a risky time for a mother and her newborn”.

Approximately one-third of the 3.1 million neonatal deaths that occur each year can be attributed to infections that develop into life-threatening conditions. The umbilical cord is a common entry point for infection to the surrounding tissue as well as internally into the baby’s bloodstream.

“These studies provide evidence of a simple, low-cost technology that can prevent illness and death for the most vulnerable children. USAID is committed to transforming research into better results and access to life-saving interventions,” Dr Shah added.

A similar study was conducted in Pakistan by researchers from Aga Khan University where data showed that cord cleansing reduced the risk of infection in babies by 42 percent and mortality by 38 percent. The studies supported earlier research in Nepal, which showed that cleansing the umbilical cord with chlorhexidine resulted in a 24 percent decrease in mortality compared to children who received dry-cord umbilical care.

Neonatal deaths are responsible for more than 40 percent of an estimated 8.8 million deaths of children under the age 5 each year worldwide. Over half of such deaths are as a result of serious infection

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Sunday, January 8, 2012

$339 million for US HIV prevention

By Meluse Kapatamoyo

To curb the growing number of HIV infections in the country, the United States is to spend $339 million on HIV prevention in the year 2012.

A statement by the National Centre for HIV/AIDS, Viral Hepatitis, STD and TB prevention, said the Centers for Disease Control and Prevention had begun awarding the money to state and local health departments across the US to fund HIV prevention activities this year.

The awards are part of a five-year funding cycle and represent a critical component of CDC’s new high-impact approach to HIV prevention that better aligns resources to reflect the geographic burden of the disease.

All 50 states, eight cities, the District of Columbia, Puerto Rico, US Virgin Islands, and the six Island jurisdictions, were among the reciepients.

“With 50, 000 new HIV infections every year and tough economic environment, the need to do more with existing resources is greater than ever, “ said Kevin Fenton, M.D., director of CDC’s National Centre for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

He said, the approach to prevention funding was designed to focus on the places where needs were most urgent and on the programs that will have the most far-reaching impact.

"It will help us achieve the ambitious goals of the National HIV/AIDS Strategy with the efficiency and urgency the HIV epidemic demands.”

The funds are being allocated to individual health departments according to a formula that better matches resources to the geographic burden of HIV, as measured by the number of people reported living with HIV in each jurisdiction.

CDC is also providing the health departments with new, specific guidance for priotizing the  most effective prevention programs that will ensure that funding in many areas with heavier HIV burdens increases.

The organisation will award an additional $20 million to health departments by March 2012 as part of this funding cycle to implement innovation HIV prevention demonstration projects.

Jonathan Mermin M.D., director of CDC’s Division of HIV/AIDS Prevention said, “This latest round of funding will help them lead the nation to slow, and ultimately end, the HIV epidemic in the United States-a public imperative that could finally be achieved."

America seeks to wipe-out Zambia's malaria cases


By Meluse Kapatamoyo
Zambia is among African countries that have entered into a partnership with the United States of America to combat malaria incidence in women and children, a new report has announced.
The recently released Malaria Operational Plan (MOP) Zambia, says through the Global Health Initiative (GHI), the partnership would help Zambia scale up prevention and treatment interventions for malaria, the country’s top killer which accounts for about 50,000 deaths every year.
The President’s Malaria Initiative (PMI) is a core component of the GHI, along with HIV/AIDS, and tuberculosis. The GHI is a comprehensive effort seeking to reduce the burden of disease and promote healthy communities and families around the world.
In December 2006, Zambia was selected as one of the benefiting countries to the five-year, $1.2 billion, PMI to rapidly scale-up malaria prevention and treatment interventions in high-burden countries in Sub-Saharan Africa.
Since then, Zambia has received approximately $79 million in PMI funding. But, although the country has recorded an improvement, malaria continues to be a burden and remains the major cause of morbidity and mortality in the country.
The PMI seeks to reduce malaria-associated mortality by 70 percent compared to pre-initiative levels in the 15 original PMI countries.
By 2014, PMI has committed itself to assisting Zambia achieve the following successes in populations at risk for malaria;  85 percent of pregnant women would have slept under an Insecticide-Treated Net (ITN), while a further 85 percent of  houses in geographic areas targeted for Indoor Residual Spraying (IRS) will have been sprayed.
In addition, 90 percent of households with a pregnant woman or child under five will own at least one ITN, and 85 percent of women who have completed a pregnancy in the last two years will have received two or more doses of Intermittent Preventive Treatment in Pregnancy (IPTp) during that pregnancy.
Furthermore, the report states that by the same year, 85 percent of government health facilities would have Artemisinin- based combination therapy (ACTs) available for treatment of uncomplicated malaria, while 85 percent of children under five with suspected malaria will have received treatment with ACTs within 24 hours of onset of their symptoms.
It is expected that by 2014, PMI would have purchased 440,000 replacement long lasting nets (LLINs) and distributed them free-of-charge through ante-natal clinics, and the Zambian Anglican Council (ZAC) with assistance from Peace Corps Volunteers (PCV).
 About 70 percent of women in each of Zambia’s nine provinces who have completed a pregnancy in the last two years will have received two or more doses of IPTp during that pregnancy by the same year. 
 “The PMI will achieve this by increasing the demand for and delivery of IPTp through strengthened focused antenatal care (FANC) and behavior change communication (BCC) campaigns at both the community and national levels."

Thursday, December 15, 2011

Mwana to save children

By Meluse Kapatamoyo

MWANA, a health initiative aimed at improving the prevention of HIV transmission from mother to child has been launched to bridge the gap between Zambia’s national testing laboratories and rural community health care workers.

Prevention of Mother-To-Child Transmission of HIV has been proven effective when all guidelines are adhered to and it could be better when test results are made available within a short timeframe.

“By getting HIV infant test results into the hands of mothers in less than half the time it used to take, programme Mwana (Child) has broken through one of the bottlenecks in preventing HIV (transmission) among infants,” said UNICEF Zambia deputy representative, Shaya Asindua.

Developed and tested with the help of community health workers, local mobile service providers, software developers and several other partners, the programme uses a RapidSMS based mobile health system to deliver the results from reference laboratories to the facility using Short Messaging Service.

An infant born with HIV needs to be diagnosed and put on ARV treatment within 12 weeks of birth if it is to have any chance of survival.

The Ministry of Health and UNICEF launched Mwana (Child) on 17th November 2011 with an aim of reducing time taken to get the HIV test results to mothers and caregivers, thereby preventing mother to child HIV transmission.

In 2010, over 35,000 infants had early diagnostic testing using HIV DNA PCR technology compared to 19, 040 the previous year due to long delays in getting back the results to the caregivers, states data from the ministry of health. The results showed an improvement of turn-around times of test results delivery by 30 percent to 60 percent, with a larger impact in rural facilities. There was also an improved oversight of the test system and strengthened linkages among health facilities, community health workers and caregivers.

Dr Peter Mwaba, the ministry’s Permanent Secretary said that despite major strides having been made in expanding Early Infant Diagnosis (EID) services in Zambia, about 30 per cent of infants who contract HIV from their mothers die before the age of one, while a further 50 per cent die before the age of two if no interventions are provided.

“These deaths contribute significantly to the national under-five mortality rate. Survival rates are up to 75 percent higher for HIV-Positive newborns that are diagnosed and begin treatment within their first 12 weeks of life,” Dr. Mwaba added.

Mwana was piloted in Zambia in 2010, in 31 clinics, 13 districts spread in six provinces. Mwana collaborating partners include Boston University affiliate, The Zambia Centre for Applied Health Research and Development (ZCHARD), the Clinton Health Access Initiative (CHAI) and the Zambia Prevention, Care and Treatment Partnership.